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Facts• African American males have 7.7 times the AIDS rate as non-Hispanic white males. • American Indian/Alaska Native women have 2.5 times the AIDS rate as non-Hispanic white women. • Hispanic females have almost 5 times the AIDS rate as non-Hispanic white females. • Native Hawaiian / Pacific Islanders are twice as likely to be diagnosed with AIDS as the White population. * The most recent statistics available from the U.S. Department of Health and Human Services as of October 2010 |
US Background
The proportion of GDP that healthcare expenditure accounts for annually continues to grow with little-to-no improvement witnessed in health outcomes or quality of life. The costs associated with the care of only 10 – 15% of the publically-insured account for nearly 50% of all healthcare expenditures. This small portion of the population is often the most vulnerable and disproportionately burdened by disease; they suffer from multiple chronic illnesses, disabilities, language and cultural barriers, poverty, and mental and behavioral health issues.
Unfortunately, the US’s fragmented healthcare system has been unsuccessful in preventing these patients from slipping through the cracks. Often, a lack of coordination and a misunderstanding of the patient’s context enable these gaps to widen. Even in the most resource-rich healthcare environments, vulnerable patients struggle to navigate the system to receive the appropriate support when necessary.
Even in Boston, where several of the world’s most renowned hospitals and academic institutions are collocated, too many people living in the shadows of these institutions lack access to high-quality healthcare. Black and Latino residents represent a large portion of people living with HIV/AIDS; notably, a black woman with HIV/AIDS is 16 times more likely to die than her white counterpart.
A look toward the future
As health care becomes more and more expensive without concurrent increase in the quality of care delivered, the industry is investing in transformative initiatives to deliver value-based care, wherein health outcomes, utilization patterns, and patient/provider satisfaction increase, while costs, health care disparities, and the need for tertiary and quaternary care decrease.
To achieve these goals, accountable health care delivery systems have focused on expanding access, undertaking cross-disciplinary and team-based approaches to primary care, and adopting models that better coordinate the experience of the patient as he/she transitions between outpatient and inpatient health care settings. Many of these care management programs utilize clinic-based nurses, social workers, and pharmacists as key interventionists.
PACT contends that well-trained and supervised community health workers can further enhance care management by:
- Extending the reach of these clinic-based providers into the patient home and community, the setting in which patients experience their illness and adopt treatment recommendations
- Informing a more realistic and sensitive diagnostic and therapeutic plan by improving the team’s understanding of the patient’s psychosocial and structural context
- Focusing on health promotion and harm reduction skills-building to support wellness prevention efforts and decrease the emphasis on late-stage and high-cost disease management
- Creating strong and natural linkages between healthcare delivery systems and community-based resources
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